School refusal

School refusal is a term originally used in the United Kingdom to describe refusal to attend school, due to emotional distress. School refusal differs from truancy in that children with school refusal feel anxiety or fear towards school, whereas truant children generally have no feelings of fear towards school, often feeling angry or bored with it instead. Children’s Hospital Boston provides a chart showing the difference between the school refusal and truancy.

The term was coined as a more general alternative to school phobia, which was used to describe these youths in the past. School refusal is a broader term that recognizes that children have problems attending school for a variety of different reasons. However, these reasons might not be the expression of a true phobia, such as separation or social anxiety.

Approximately 1 to 5% of school-aged children have school refusal , though it is most common in 5- and 6-year olds and in 10-and 11-year olds. It occurs more frequently during major changes in a child’s life, such as entrance to Kindergarten or changing from elementary to middle school. The problem may start following vacations, holidays, or brief illness, after the child has been home for some time. School refusal can also occur after a stressful event, such as moving to a new house, or the death of a pet or relative.

The rate is similar within both genders , and although it is significantly more prevalent in some urban areas, there are no known socioeconomic differences.

Symptoms of school refusal include the child saying they feel sick often, or waking up with a headache, stomachache, or sore throat. If the child stays home from school, these symptoms might go away, but come back the next morning before school. Additionally, children with school refusal may have crying spells or throw temper tantrums.

Warning signs of school refusal include frequent complaints about attending school, frequent tardiness or unexcused absences, absences on significant days (tests, speeches, physical education class), frequent requests to call or go home, excessive worrying about a parent when in school, frequent requests to go to the nurse’s office because of physical complaints, and crying about wanting to go home.

It is important for parents to keep trying to get their child to go back to school. The longer a child stays out of school, the harder it will be to return. However, it may be hard to accomplish as when forced they are prone to temper tantrums, crying spells, psychosomatic or panic symptoms and threats of self-harm. These problems quickly fade if the child is allowed to stay home.

Parents should take their child to the doctor, who will be able to rule out any illness that may be causing the problem. Parents should also talk to the child’s teacher or school counselor. Although school refusal is not a clinical disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, it can be associated with several psychiatric disorders, including Separation Anxiety Disorder, Social Phobia, and Conduct Disorder. Therefore it is critical that youths who are school refusing receive a comprehensive evaluation by a mental health professional.

Whereas some cases of school refusal can be resolved by gradual re-introduction to the school environment, some others may need to be treated with some form of psychodynamic or cognitive-behaviour therapy. Some families have sought alternative education for school refusers which has also proved to be effective. In extreme cases, some form of medication is sometimes prescribed but none of these have stood out prominently as solutions to the problem.

A medical condition often mistaken for school refusal is delayed sleep phase syndrome (DSPS). DSPS is a circadian rhythm sleep disorder which causes difficulty falling asleep at night and waking in the morning.

Factors that cause school refusal behavior

Factors that can cause reluctance to attend school can be divided into four categories. These categories have been developed based on studies in the United States under the leadership of Professor Christopher Kearney. Some people may be affected by several factors at once.

It may be possible that the child wants to avoid school-related issues and situations that cause unpleasant feelings in her or him, such as anxiety, depression, or psychosomatic symptoms. The reluctance to attend school is one symptom that can indicate the presence of a larger issue, such as anxiety disorder, depression, sleep disorder, separation anxiety or panic disorder.

It may also be that the child wants to avoid tests, presentations, group work, specific lessons, or interaction with other children.

Third, the child may want attention from significant people outside of school, such as parents or older acquaintances.

Finally, it may be that the child wants to do something more enjoyable outside of school, like practice hobbies, play computer games, watch movies, play with friends such as riding bikes, etc., or learn autodidactictly.

Helpful Resources

National Association of School Psychologists: Information for Families, http://www.nasponline.org/families/index.aspx

Anxiety Disorders Association of America, http://www.adaa.org/living-with-anxiety/children/school-refusal

Getting Your Child to Say "Yes" to School: A Guide for Parents of Youth with School Refusal Behavior Christopher Kearney, Ph.D., Director of the UNLV Child School Refusal and Anxiety Disorders Clinic at the University of Nevada, Las Vegas

See also

• Bullying
• Hikikomori
• Truancy
• Fushūgaku

Notes

• Fremont, Wanda P.; Smucny, John (2003). "School Refusal in Children and Adolescents". American Family Physician 68 (8): 1555–1561. PMID 14596443. http://www.aafp.org/afp/20031015/1555.html. 

External links

• Scared of School - Site for teenagers who like to learn but are scared of school for various reasons
• School Refusers - Site for parents of children who refuse to attend school
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